Reported skin cancer screening of US adult workers

Early detection of skin cancer by skin examination may reduce its associated morbidity and mortality, in particular for workers routinely exposed to sun

Melanoma Epidemiology and Disparities in Nonwhite Populations

Melanoma is among the top ten most common cancers in the US. The health care delivery system patients participate in may affect access to, and utilization of, health care resources that may determine health outcomes. Much of the current literature has addressed lighter-skinned populations since these individuals are at greatest risk of developing melanoma. This Dissertation is focused on melanoma in nonwhite populations and the effect of health care delivery and access to care on outcome. Specifically, our aims were to review the literature in the area of melanoma among nonwhite populations and compare the incidence of melanoma among nonwhite populations in Florida to the US. Additionally, we sought to determine the stage of melanoma diagnosis for a 12 year period in fee-for-service (FFS) and health maintenance organizations (HMO), to determine if differences in mortality exist between these systems of health care delivery and if established involvement in a health care delivery system may, in part, be responsible for any differences seen in stage of diagnosis and survival. We found non-Hispanic black (NHB) females and Hispanic males in Florida had significantly higher incidence rates of invasive melanoma than their counterparts in the US, 60% and 20% respectively. We also found that Hispanic Medicare patients enrolled in HMO health care delivery systems were less likely to receive a diagnosis of regional versus earlier stages of melanoma compared to Hispanic patients enrolled in FFS systems. Additionally, non-Hispanic white (NHW) Medicare patients enrolled in HMO health care delivery systems were less likely to be diagnosed at a later stage of melanoma compared to NHW patients enrolled in FFS systems. Targeted educational interventions and earlier detection of melanoma are fundamental components of cancer prevention and control efforts aimed at decreasing mortality. More comprehensive medical training, expanded public education campaigns, and increased awareness among patients of all skin types to perform self-skin checks are highly recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are needed. We recommend investigation of possible differences in the etiology of melanoma among darker-skinned individuals as well as differences between health care delivery systems.</p

Melanoma in Hispanics

Although age-adjusted incidence rates (per 100,000 population) for melanoma are lower among Hispanics (4.5) compared with non-Hispanic whites (21.6), melanoma in Hispanics is more likely to be diagnosed at more advanced stages, resulting in higher mortality than non-Hispanic whites in the USA. It is likely due to, in part, a lower index of suspicion in both the healthcare providers and the minority populations and, as such, diagnosis is often delayed, resulting in advanced presentation and a worse prognosis. More comprehensive medical training, expanded public education campaigns and increased awareness among patients of all skin types to perform self skin checks are highly recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are needed

Differences in melanoma outcomes among Hispanic Medicare enrollees

Hispanics are given the diagnosis of melanoma at later stages and have reduced survival. We sought to evaluate the effect of Hispanic ethnicity and different health care delivery systems (fee-for-service [FFS] and health maintenance organizations) on melanoma stage at diagnosis and survival. We studied a retrospective cohort of 40,633 patients, with at least 3 years of follow-up, who were given the diagnosis of incident melanoma from 1991 to 2002 and were 65 years or older using data from the Surveillance, Epidemiology, and End Results–Medicare linked database. The analytic sample consisted of 39,962 non-Hispanic whites (NHW) and 671 Hispanics. Logistic regression models examined the roles of the health care delivery system and race/ethnicity in stage at diagnosis and survival. For FFS patients, Hispanics were more likely to be given a diagnosis at an advanced stage (distant vs earlier stages [odds ratio {OR} = 2.07; 95% confidence interval {CI} = 1.36-3.16]; regional vs earlier stages [OR = 2.31; 95% CI = 1.75-3.03]) compared with NHW. Among Hispanic patients, those enrolled in health maintenance organizations were less likely to be given a diagnosis at later stage (regional vs earlier stages [OR = 0.50; 95% CI = 0.31-0.81]) than FFS patients; however, the earlier stage at diagnosis did not improve survival. For patients with a previous cancer before their melanoma diagnoses, NHW enrolled in health maintenance organizations from 1991 to 2002 were given a diagnosis at earlier stages compared with NHW FFS patients (OR = 0.72; 95% CI = 0.52-0.99); this was not found among Hispanics. These results reflect findings in a Medicare-aged population and it is not clear if they are generalizable to younger patients. Differences in melanoma outcomes among different ethnic groups are, in part, dependent on the health care setting in which patients are enrolled

Tumor necrosis factor-α in vitiligo: direct correlation between tissue levels and clinical parameters

Background: Experimental evidences have shown that tumor necrosis factor (TNF)-α may play a role in the pathogenesis of nonsegmental vitiligo, and successful cases of vitiligo treated with TNF-α inhibitors have been recently reported. Materials and methods: Two cases of refractory generalized vitiligo, which showed high tissue levels of TNF-α, were commenced anti-TNF-α antibody etanercept 50 mg weekly. A retrospective study, considering chart review and immunohistochemical staining for TNF-α, was then carried out on eight additional patients affected by untreated vitiligo. Results: Etanercept achieved improvement of vitiligo in two patients at 6-month follow-up. Five out of eight specimens showed a strong cytoplasmic staining for TNF-α. Considering all 10 cases, patients with a strong TNF-α staining were characterized by a higher vitiligo disease activity score than patients with a weak staining. Discussion: These findings, albeit limited in significance by the low number of cases and the retrospective nature of the study, confirm a probable role of TNF-α in the pathogenesis of vitiligo. The intensity of TNF-α staining in vitiligo lesions may be worth to be further studied as a biomarker for potentially successful anti-TNF-α treatment of nonsegmental vitiligo in cases refractory to conventional treatment

Adiposis dolorosa

We report a 46-year-old woman with a nine-year history of obesity; chronic diffuse pain in the adipose tissue of her medial upper arms, lower trunk, and thighs; multiple biopsy-proven lipomas and angiolipomas; and a lipomatous pseudomass of the breast. Her systemic symptoms included generalized weakness, fatigue, memory impairment, and arthralgias. Although some of the lesions were tender, most were only appreciated with palpation. Her clinical history and histopathologic data suggested adiposis dolorosa (Dercum’s disease). Owing to the chronic pain, an interdisciplinary approach with the use of analgesics and doxycycline has been initiated